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Clinical Challenges in Otolaryngology
April 2005

Laryngeal Asymmetry on Indirect Laryngoscopy in a Symptomatic Patient Should Be Evaluated With Electromyography

Author Affiliations

Author Affiliation: Department of Otolaryngology–Head and Neck Surgery, Feinberg School of Medicine at Northwestern University, Chicago, Ill

Arch Otolaryngol Head Neck Surg. 2005;131(4):356-359. doi:10.1001/archotol.131.4.356

Hypothesis: Laryngeal asymmetry seen on indirect laryngoscopy in a symptomatic patient with hoarseness should be evaluated with laryngeal electromyography (LEMG).

Laryngeal asymmetry is sometimes encountered in patients who present for evaluation of hoarseness. This asymmetry may have a number of different causes, but a principal concern of the clinician is vocal fold paralysis and paresis. While the use of computed tomography (CT) to visualize the course of the superior and recurrent laryngeal nerves is considered paramount to determine if a neoplasm with nerve involvement is present, the appropriate clinical approach to such a patient with symptomatic hoarseness and laryngeal asymmetry is controversial. Furthermore, there is no clear consensus on the choice and timing of intervention to improve the patient’s voice.

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